Department of Gastroenterology

Oslo University Hospital

Centre for Colorectal Cancer Screening

"With the capsule's relatively low sensitivity for the detection of colorectal lesions, [and] its requirement for more extensive bowel-cleansing regimens as compared with colonoscopy and CT colonography…colon capsule endoscopy cannot be recommended at this time," concluded Dr. Michael Bretthauer of Oslo University Hospital Rikshospitalet in an editorial that accompanied the trial's publication in the July 16 New England Journal of Medicine.

The finding suggests that an initial screening could be used to separate patients into high-risk and low-risk groups, said Michael Bretthauer, a gastroenterologist who co-wrote an editorial accompanying the study.
High-risk patients, those with precancerous polyps, benefited from getting repeated colonoscopies afterwards, he said.

When no precancerous polyps are found in a patient "you can just forget about them, send them home," said Bretthauer, at Oslo University Hospital Rikshospitalet in Norway, in a telephone interview.

"Since the size of colorectal lesions is a predictor of the development of cancer, the relatively lower sensitivity of capsule endoscopy for the detection of large adenomas is cause for concern," Dr. Michael Bretthauer of Oslo University Hospital in Norway wrote in a commentary on the study.

...

"With the capsule's relatively low sensitivity for the detection of colorectal lesions, its requirement for more extensive bowel-cleansing regimens as compared with colonoscopy and CT colonography, and its high cost, colon capsule endoscopy cannot be recommended at this time," Bretthauer wrote.

"An appealing concept would be to use colonoscopy as a triage screening test, offering it once for everybody at 60 years of age" and using it to classify people into high- and low-risk categories, Dr Michael Bretthauer of Oslo University Hospital and Dr Mette Kalager of Telemark Hospital, both in Norway, wrote in an editorial in the journal.

Based on the results, "an appealing concept would be to use colonoscopy as a triage screening test, offering it once for everybody at 60 years of age" and using it to classify people into high- and low-risk categories, Dr. Michael Bretthauer of Oslo University Hospital and Dr. Mette Kalager of Telemark Hospital, both in Norway, wrote in an editorial in the journal.

...

Bretthauer and Kalager cautioned in their editorial that "the study mimics a situation in which 100 percent of the population complies with screening, which is not a real-life scenario."